To understand the nursing role in the advance directive decision, nurses how are key members in the implementation of a hospice protocol will be studied. The methods of grounded theory will be used to: study the moral reasoning and clinical decision making of nurses who recommend levels of medical intervention; identify the characteristics of patients associated with the various levels of medical intervention recommended by nursing staff; study the process by which nursing staff obtain a consensus for recommending a level of medical intervention to the family members of patients who have Alzheimer's disease; develop an empirically generated bioethical and clinical decision making model for recommending a level of medical intervention; and identify the content domain for making the model variables operational so that the necessary instruments can be developed to test the model in a follow-up study. Data collection will consist of observing and tape recording about 25 nursing consensus meetings, interviewing nurses and being participant observers when a consensus decision is likely to be discussed at change of shift report and coffee breaks. Data analysis will be conducted using the constant comparative analysis technique of collecting and analyzing data first with a general theoretical perspective and then with a more structured format. Both the manual system and a computer program for sorting data bits to derive core categories, identifying the properties of categories, their hierarchical arrangements and their relationships will be used. The core variables will be completely described as the first step in instrument development. The follow-up study will test the model in other settings. The findings can be applied to nursing practice for developing guidelines to articulate the role of the nurse in the area of advance directives.